| NPI | 1518255157 |
|---|---|
| Former Name | KELLIE DIANNE TAPPAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT28376) |
| Additional Taxonomies | 174400000X Specialist (Licence: DE J1-0002716) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2024-03-27 |